A 45-year-old woman presented herself with a complaint that she had incontinence of urine for about 5 years. She often realized that she had passed urine only when her clothes were wet. Most of the time, the quantum of urine passed was substantial. She was holding a corporate job which did not involve any strenuous physical activity but required frequent traveling including trips abroad. She did not have any major medical or surgical illness.

This patient had two uneventful normal vaginal deliveries at the age of 30 and 32 years.

She claimed that the reason for not seeking any medical help for her urinary incontinence problem all this while was busy schedule of her job. Though she was advised to consult me earlier, she turned up only 2 years later. She felt an urgent need to do something about her urinary problem, as she was soon to take a long trip abroad. She consulted another lady gynecologist. This gynecologist assured her that her urinary incontinence can be set right by an operation on day-care bases. The gynecologist was even ready to schedule the surgery in next few days. However, she declined surgical intervention and returned to our clinic.

When this patient came to me, she told me how she needed to fix her urinary incontinence on an urgent basis. I could do only routine gynecology examination for her as the she did not have any urine in her bladder. I called her the next day with full bladder for another examination. The second examination revealed that there was no clinical evidence of stress urinary incontinence (SUI) but also there was no suspicion of any other type of urinary incontinence. Urodynamic studies were advised, as in my opinion her problem was not SUI. Fortunately for her, she agreed and got the urodynamic evaluation done. The report was "No SUI, No Detrussor over activity or any other type of Incontinence. Normal bladder compliance."

After having the urodynamic evaluation at hand, I went through more detailed history and carried out repeat clinical examination. A detailed history at this time was surprisingly revealing the possible underlying cause. This patient was obsessed with drinking water. She would consume anywhere between 8 to 9 liters of water on any given day. This resulted in forced diuresis, overfilling her bladder every hour. At any time, if she could not get an opportunity to empty the bladder, she would get incontinent.

I explained to her that her problem was her own creation, and that she did not have any urinary incontinence of any type and she did not need any operation. She should restrict her water intake to 1½ to 2 litres a day, which should be well distributed throughout the day, to have good bladder habit of emptying it at least every three hours. The patient followed the advice, had her trip abroad, and returned after a month to report that she was free of her incontinence. She was thankful that she was saved from an unnecessary surgery.

There have been more than 100 different operations for clinical SUI. All this while, Burch colposuspension has been the gold standard operation for most of the cases of SUI. During the last decade, with the advent of tension-free sling operations like Transobturator Tape and tension-free vaginal tape (TVT), Burch colposuspension has gone in background, as it is more complex operation, involving laparotomy, while tension-free sling operations are supposed to be easy to learn and easy to do with virtually no complications. Though TVT procedures for SUI are minimally invasive, simple, quick (usually taking less than 30 minutes), the claim that there are "virtually no complications" with tension-free sling operations, is greatly misplaced. The complications though rare, they are 1) injury to pelvic blood vessels 2) injury to urinary bladder and bowel and 3) post operative difficulty in micturition. History has shown that easy to do operations more often are misused rather than rightly used. There is a misplaced argument that "even if it does not help it would not do any harm."

More than 50% of women will give H/O passage of small amount of urine, at some time or the other. All of them are not cases of clinical SUI, needing treatment, which is a surgical operation. Urinary incontinence is not an uncommon symptom in premenopausal and menopausal women. This symptom needs to be diagnosed correctly as a sign, so as to institute the right treatment; especially in SUI wherein the treatment is an operation, however simple the operation may be. The above case should be a lesson for how important it is to take thorough history and carry out proper clinical examination, which will help to make a diagnosis in 80% of cases. Only in 20% of cases, one may need to proceed to investigations and only in 10%, sophisticated investigations will be required. An operation carried out when not needed or indicated is likely to do more harm than good. First principle in medicine is "DO NO HARM."